Get Permission Hussain, Tiwary, and Singh: Questionnaire based observational study of association of pruritus with intake of food items in common skin disorders


Introduction

Pruritus is an unpleasant sensation which provokes a tendency to scratch which is a common symptom of majority of dermatological & few systemic disorders.1 Stimulus for pruritus is perceived by intraepidermal nerve fibers with free nerve endings extending into stratum granulosum, from where it is carried by unmyelinated afferent histamine sensitive C- fibers to lateral spinothalamic tract then finally to higher centres namely anterior and posterior cingulate cortex, somatosensory areas I and II, supramarginal gyrus & inferior parietal lobe.2 This multi-dimensional process of itch sensation is mediated via release of chemical mediators; primarily by Histamine, Tryptase, Cathepsin S, Interleukin-31; secondarily via Prostaglandin E-1,2, Substance- P, u- opioid receptor agonist, Nerve growth factor, Interleukin-2 etc.3

Various chemicals present in certain food items are known to trigger release of pruritogenic mediators like- ovalbumin, ovomucin in eggs,4 parvalbumin in fishes,5 oleosins, legumin and vicilins in nuts.6 Similarly, various phytochemicals in fruits and vegetables like-glucosinolates in brassica family vegetables, carotenoids in spinach, parsley and green onion, flavonols in tomato, onion and lettuce and anthocyanidins in grapes are known to trigger itching is some individuals.7 Similarly, a variety of bioactive components have been shown to modulate inflammatory responses.8 In certain spicy foods, there is an active chemical called microptaprotomerase that is easily absorbed into the blood stream. Butylated hydroxytoluene (BHT) and Butylated hydroxyanisole (BHA) are preservative chemicals added to cereals and other grain products to prevent them from changing color, odor, and flavor which have been associated with chronic allergic triggers.9 The chemical eventually affects the hair follicles and accumulates on scalp and causes itching. 10

There are various myths about diet in the common population that consumption of certain food items exacerbates their pruritus, which needs proper study for further counseling and guidance of patients while treating pruritic skin disorders.

This study aims to establish if there is any actual correlation between food items in the aggravation of pruritus in pruritic skin conditions or if isit just a common myth!.

Materials and Methods

The study was conducted in a tertiary care hospital in Patna, Bihar. The duration of study was 6 months from January 2021 to June 2021. The patients presenting to the Dermatology OPD with pruritic skin disorders, were included in the study. It was a cross sectional study of 306 patients wherein the study subjects were asked questions related to their demography, food habits and association of any specific food items with exacerbation of itching. Cases with pruritic skin disorders such as eczematous disorders, fungal infections, urticaria, generalised pruritus, psoriasis, lichen planus were included in the study. Association of specific food items like fish, egg, curd, spicy vegetables, pickles and others (if any) to cause exacerbation in itching was enquired with the patients and the response were noted.

Observation & Results

The total number of cases included in the study were 306, all belonging to groups of pruritic skin disorders such as eczema, fungal infections, scabies, psoriasis, lichen planus, etc. Table 1 depicts the age & gender distribution of the study subjects in which the maximum cases were in the age group 10-40 years, & male: female ratio was 9:8. Out of the total cases, 177 belonged to urban areas and 129 belonged to rural area. Regarding the educational status of study participants, 65 were illiterate, & 241 were literate.Table 2 shows the incidence of various pruritic skin conditions found in the study subjects. It was observed that the maximum cases were of fungal infections followed by eczematous disorders followed by urticaria and psoriasis. Out of the total study subjects, 147 (48%) complained about exacerbation in itching after eating some specific food items whereas 159 (52%) cases had no such association. Out of 147 patients, 69 had an association with a single food item and 72 had an association with multiple food items causing pruritus. Among the group of eczematous disorder cases, 42 cases reported exacerbation and 48 did not have any such association (Table 3). Among the group of fungal infections, 53 cases reported exacerbation and 61 did not have any such association (Table 4). Among urticaria patients, 16 cases reported exacerbation in pruritus whereas 18 did not have such complaints (Table 5). Among cases of generalized pruritus, 06 cases reported exacerbation in pruritus whereas 02 did not have such complaints (Table 6). Out of the total patients with pruritic disorders, 53.30% of cases had an exacerbation of pruritus after food intake (Table 7). Considering the association of individual food items, spicy vegetables like brinjal, and jackfruits were the most common culprits followed by fish followed by pickles and curd (Table 8). Table 8 also depicts the association of each food item causing exacerbation in itching with respective pruritic dermatoses.

Table 1

Age and gender distribution

Age

Male

Percentage

Female

Percentage

Total

<10

3

0.98%

6

1.96%

9

10-19

39

12.75%

30

9.80%

69

20-29

42

13.73%

21

6.86%

63

30-39

21

6.86%

45

14.70%

66

40-49

18

5.88%

18

5.88%

36

50-59

18

5.88%

24

7.84%

42

>60

21

6.86%

0

0%

21

Total

162

52.94%

144

47.05%

306

Table 2

Area distribution

Age

Rural

Percentage

Urban

Percentage

Total

<10

3

0.98%

6

1.96%

9

10-19

9

2.94%

60

19.61%

69

20-29

18

5.88%

45

14.70%

63

30-39

36

11.76%

30

9.80%

66

40-49

21

6.86%

15

4.90%

36

50-59

30

9.8%

12

3.92%

42

>60

12

3.92%

9

2.94%

21

Total

129

42.15%

177

57.84%

306

Table 3

Educational status

Educational status

No. of patients

Percentage

Mean±SD

Illiterate

65

21.24%

61.20±34.07

Matriculation

116

37.90%

Under graduate

59

19.28%

Graduate

37

12.09%

Post graduate

29

9.48%

Total

306

100%

Table 4

Pruritic conditions

Pruritic conditions

No. of patients

Percentage

Mean±SD

Eczema

90

29.41%

43.71±41.62

Fungal Inf.

114

37.25%

Urticaria

34

11.11%

Generalised pruritus

8

2.61%

Others-scabies

15

4.90%

Psoriasis

33

10.78%

Lichen Planus

12

3.92%

Total

306

100%

Table 5

Association with food items

Association with food items

No. of patients

Percentage

Mean±SD

P. value

Yes

147

48.04%

153.00±8.48

0.02

No

159

51.96%

Total

306

100%

Table 6

Exacerbation with multiple food items

Exacerbation with multiple food items

No. of patients

Percentage

Mean±SD

P. value

Single food items

69

48.9%

70.50±2.12

0.014

Multiple food items

72

51.1%

Table 7

Exacerbation in itching after food intake (Eczema)

Exacerbation in itching after food intake (Eczema)

No. of patients

Percentage

Mean ± SD

P. value

Yes

42

46.7%

45.00±4.24

0.04

No

48

53.3%

Table 8

Exacerbation in itching after food intake (Fungal)

Exacerbation in itching after food intake (Fungal)

No. of patients

Percentage

Mean±SD

P. value

Yes

53

46.5 %

57.00±5.65

0.04

No

61

53.5%

Table 9

Exacerbation in itching after food intake (Urticaria)

Exacerbation in itching after food intake (Urticaria)

No. of patients

Percentage

Mean±SD

P. value

Yes

16

47.4%

17.00±4.24

0.03

No

18

52.6%

Table 10

Exacerbation in itching after food intake (Generalised pruritus)

Exacerbation in itching after food intake (Generalised pruritus)

No. of patients

Percentage

Mean±SD

P. value

Yes

06

75%

4.00±2.82

0.295

No

02

25%

Table 11

Exacerbation in itching after food intake (Others)

Exacerbation in itching after food intake (others)

No. of patients

Percentage

Mean±SD

P. value

Yes

28

46.7%

30.00±2.82

0.04

No

32

53.3%

Table 12

Association of individual food items with variousdermatoses

Association of individual food items with dermatoses

Eczema

Fungal

Urticaria

Gen. Pruritus

Others

Total

P. Value

Fish

21

10

8

1

5

45

0.055

Egg

10

8

7

2

4

31

0.012

Curd

8

8

5

2

7

30

0.006

Vegetables

31

28

12

1

14

86

0.035

Non Veg. items

2

4

2

1

2

11

0.011

Pickles

8

12

5

2

9

36

0.014

Discussion

The total number of patients studied was 306 out of which 162 were males and 144 were females, the gender ratio was 9:8. The number of patients from urban area were 177 and rural area were 129. Since the study centre is in urban area of Patna, it is easier for urban population to assess the hospital for skin disorders in comparison to the residents of rural areas, hence the number of patients from urban areas were more as compared to the rural area in our study. The youngest and eldest patients included in the study were 8 and 72 years old respectively and the maximum number of the patients belonged to the age group 10-40 years.

Out of the total number of patients in the study, a maximum of 114 patients were of fungal infections, 90 were of eczematous dermatitis, 34 were of urticaria, 33 were of psoriasis, 15 were of scabies, 12 were of lichen planus and 8 were of generalized pruritus. Among them exacerbation in pruritus on intake of certain food items was found in 147 out 306 patients (Mean- 153.00 ±8.48; p-value- 0.02), among which 69 complained of exacerbation with single food whereas 72 showed exacerbation with the intake of multiple food items (Mean-70.50 ±2.12; p-value- 0.014). Among eczema patients 42 out of 90 had increased pruritus after specific food intake (Mean- 45.00±4.24; p value- 0.04). Food allergies are considered an essential comorbidity of atopic dermatitis alongside asthma & allergic rhinitis (hay fever). 11, 12 Among fungal infection patients 53 out of 114 had such association (Mean-57.00±5.65; p value- 0.04). Various studies have proven allergic cross-reactivity between various food allergens and fungi with both food products and fungal cell walls having the same components.13 Among patients of Urticaria, 16 out of 34 had such an association (Mean-17.00±4.24; p-value- 0.03). Education on dietary modification has been a key component in managing chronic urticaria, however only a subset of patients get a benefit. 14 In the group of patients that comprised of other pruritic disorders like scabies, psoriasis, and lichen planus, it was found that 28 out of 60 patients had increased pruritus after intake of certain food items (Mean- 30.00±2.82; p-value- 0.04). In food-allergic patients with atopic dermatitis, the ingestion of the food item can provoke the whole spectrum of IgE-mediated symptoms, from oral allergy syndrome to severe anaphylaxis. 15 However in patients of generalized pruritus without a specific cause, the association was insignificant.

In specific food items, it was observed that spicy vegetables like brinjal, jackfruit, onion & garlic were the most common culprits causing pruritus in 86 patients (p-value- 0.035). It was followed by fish which exacerbated pruritus in 45 patients (p-value- 0.055) followed by egg and curd involving 31 patients (p-value- 0.012) and 30 patients (p-value- 0.006) respectively.

Hence, we can conclude that exacerbation in pruritus in various pruritic skin disorders is not merely a myth and in fact, there is an association with some food items that may increase the pruritus after their consumption. Ingested food antigens rapidly cross the gastrointestinal barrier and reach pro-inflammatory cells in the skin.16 When the skin is inflamed by any disease pathology, its threshold to flare is low and many things can trigger a pruritic sensation. So, proper counseling of avoidance of such specific food items will help the patients relieve their pruritus and hence better management of the underlying diseases.

Source of Funding

None.

Conflict of Interest

None.

References

1 

YA Tivoli RM Rubenstein Pruritus: An updated look at an old problemJ Clin Aesthet Dermatol200927306

2 

S Stander E Weishaar T Luger Neurophysiological and neurochemical basis of modern pruritus treatmentExp Dermatol20071731619

3 

O Hägermark Itch mediatorsSemin Dermatol19951442716

4 

K Honma M Aoyagi K Saito T Nishimuta K Sugimoto H Tsunoo Antigenic determinants on ovalbumin and ovomucoid: comparison of the specificity of IgG and IgE antibodiesArerugi1991409116775

5 

T Van Do S Elsayed E Florvaag I Hordvik C Endresen Allergy to fish parvalbumins: studies on the cross-reactivity of allergens from 9 commonly consumed fishJ Allergy Clin Immunol20051166131420

6 

V Leduc DA Moneret-Vautrin JT Tzen M Morisset L Guerin G Kanny Identification of oleosins as major allergens in sesame seed allergic patientsAllergy200661334956

7 

A Kumar PN Kumar M Jose A Tomer V Oz E Proestos Major Phytochemicals: Recent Advances in Health Benefits and Extraction MethodMolecules202328288710.3390/molecules28020887

8 

YS Kim MR Young G Bobe NH Colburn JA Milner Bioactive food components, inflammatory targets, and cancer preventionCancer Prev Res (Phila)2009232008

9 

SC Lourenço M Moldão-Martins VD Alves Antioxidants of Natural Plant Origins: From Sources to Food Industry Applications Molecules20192422413210.3390/molecules24224132

10 

P Kesika B S Sivamaruthi S Thangaleela M Bharathi C Chaiyasut Role and Mechanisms of Phytochemicals in Hair Growth and HealthPharmaceuticals (Basel)202316220610.3390/ph16020206

11 

N Papapostolou P Xepapadaki S Gregoriou M Makris Atopic Dermatitis and Food Allergy: A Complex Interplay What We Know and What We Would Like to LearnJ Clin Med20221114931739410.3390/jcm11144232PMCID

12 

S Narla J Silverberg The Role of Environmental Exposures in Atopic DermatitisCurr Allergy Asthma Rep202020127410.1007/s11882-020-00971-z

13 

H Xing J Wang Y Sun H Wang Recent Advances in the Allergic Cross-Reactivity between Fungi and FoodsJ Immunol Res2022758340010.1155/2022/7583400

14 

J Jaros VY Shi R Katta Diet and Chronic Urticaria: Dietary Modification as a Treatment StrategyDermatol Pract Concept2019101e202000410.5826/dpc.1001a04PMCID

15 

B Wüthrich Food-induced cutaneous adverse reactionsAllergy19465346 Suppl1315

16 

HA Sampson Mechanisms in adverse reactions to food. The skinAllergy19205020 Suppl4651PMID



jats-html.xsl


This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

  • Article highlights
  • Article tables
  • Article images

Article History

Received : 13-02-2024

Accepted : 05-07-2024


View Article

PDF File   Full Text Article


Copyright permission

Get article permission for commercial use

Downlaod

PDF File   XML File   ePub File


Digital Object Identifier (DOI)

Article DOI

https://doi.org/10.18231/j.ijced.2024.048


Article Metrics






Article Access statistics

Viewed: 361

PDF Downloaded: 71



Medical Abbreviation List